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1.
This paper first applies the sequential cluster method to set up the classification standard of infectious disease incidence state based on the fact that there are many uncertainty characteristics in the incidence course. Then the paper presents a weighted Markov chain, a method which is used to predict the future incidence state. This method assumes the standardized self-coefficients as weights based on the special characteristics of infectious disease incidence being a dependent stochastic variable. It also analyzes the characteristics of infectious diseases incidence via the Markov chain Monte Carlo method to make the long-term benefit of decision optimal. Our method is successfully validated using existing incidents data of infectious diseases in Jiangsu Province. In summation, this paper proposes ways to improve the accuracy of the weighted Markov chain, specifically in the field of infection epidemiology.  相似文献   

2.
Human bocavirus 2 genome was detected from the mucus secretion of a 4-year-old girl afflicted by plastic bronchitis. Since human bocavirus 1 has been detected from intratracheal aspirate and acute-phase serum from a patient with plastic bronchitis, human bocaviruses 1 and 2 might be directly or indirectly responsible for inflammation of the lungs followed by mucous plugging.  相似文献   

3.
Several subtypes of avian influenza A have been shown to cross the species barrier and infect humans, leadingto human cases of avian influenza) Till June 2, 2009, globally there were 433 confirmed human cases of avian influenza caused by H5N1 virus, with a death rate of 60.5%.3 This is far higher than the reported 11% death rate of severe acute respiratory syndrome (SARS).4 The epidemiologic features of human case of influenza A subtype H5N1 virus infection consist of high incidence rate in cold weather, high susceptibility in population of younger age associated with rapid onset of the disease and devastating illness in humans.12'5'6 H5N1 virus is mostly transmitted to humans directly through contact with infected birds or their secretions and the patients present with an influenza type illness with fever, cough, sore throat, malaise, and gastrointestinal symptoms; which can result in a rapidly progressive primary viral pneumonia and respiratory failure.2 Patients above the age of 5 years are likely to have an adverse course of disease.5  相似文献   

4.
Objectives Tumor necrosis factor-α (TNF-α) may play an important role in host's immune response to mycobacterium tuberculosis (M. tuberculosis) infection. This study was to investigate the association of TNF-α gene polymorphism with pulmonary tuberculosis (TB) among patients with coal worker's pneumoconiosis (CWP). Methods A case-control study was conducted in 113 patients with confirmed CWP complicated with pulmonary TB and 113 non-TB controls with CWP. They were matched in gender, age, job, and stage of pneumoconiosis. All participants were interviewed with questionnaires and their blood specimens were collected for genetic determination with informed consent. The TNF-α gene polymorphism was determined with polymerase chain reaction of restriction fragment length polymorphism (PCR-RFLP). Frequency of genotypes was assessed for Hardy-Weinberg equilibrium by chi-square test or Fisher's exact probability. Factors influencing the association of individual susceptibility with pulmonary TB were evaluated with logistic regression analysis. Gene-environment interaction was evaluated by a multiplieative model with combined OR. All data were analyzed using SAS version 8.2 software. Results No significant difference in frequency of the TNF-α-308 genotype was found between CWP complicated with pulmonary TB and non-TB controls (2,2=5.44, P=-0.07). But difference in frequency of the TNF-α-308 A allele was identified between them (2,2-5.14, P=0.02). No significant difference in frequencies of the TNF-α-238 genotype and allele (P=0.23 and P=0.09, respectively) was found between cases and controls either, with combined (GG and AA) OR of 3.96 (95% confidence interval of 1.30-12.09) at the -308 locus of the TNF-α gene, as compared to combination of the TNF-α-238 GG and TNF-α-308 GG genotypes. Multivariate-adjusted odds ratio of the TNF-α-238 GG and TNF-α-308 GA genotypes was 1.98 (95% CI of 1.06-3.71) for risk for pulmonary TB in patients with CWP. There was a synergic interaction between the TNF-a-308 GG genotype and body mass index (OR=4.92), as well as an interaction between the TNF-α-308 GG genotype and history of BCG immunization or history of TB exposure. And, the interaction of the TNF-α-238 GG genotype and history of BCG immunization or TB exposure with risk for pulmonary TB in them was also indicated. Conclusions TNF-α-308 A allele is associated with an elevated risk for pulmonary TB, whereas TNF-α-238 A allele was otherwise.  相似文献   

5.
目的建立无偏灰色马尔科夫预测模型,对传染病发病率时间序列进行预测。方法利用2003~2009中国肺结核发病率数据建立无偏灰色预测模型,马尔科夫模型修正预测结果,用2010年数据来检验模型,再利用模型对2011年中国肺结核发病率进行预测。结果中国肺结核发病率的无偏灰色模型为x^(0)(1)=74.64,x^(0)(k)=96.2323e1n 0.9685(k-1)(k=2,3,…,n),运用马尔科夫模型修正后,预测模型相对误差为3.188%。2011年肺核病发病率预测值为77.877/10万。结论无偏灰色马尔科夫模型预测精度高于传统灰色预测模型和单一的无偏灰色模型,是一种传染病发病率短期预测精度较高的预测模型。  相似文献   

6.
目的 收集四川省肿瘤医院头颈部肿瘤患者住院病案信息数据,探讨不同缺失场景下数据缺失值通过完成者数据集法、期望-极大化法(EM)、马尔可夫链-蒙特卡洛法(MCMC)3种方法处理后的标准化住院天数对标准化住院费用对数值的回归系数估计值r的优劣。方法 运用R 3.4.1软件,采用蒙特卡洛模拟,通过设定缺失比例和缺失机制模拟不同场景的缺失数据集,运用完成者数据集法、期望-极大化法、马尔可夫链-蒙特卡洛法估计不同缺失场景的模拟数据集中标准化住院天数对标准化住院费用对数值的回归系数估计值r,并与完整数据集的回归系数估计值rc结果进行比较,从准确度(各种方法估计的r与rc比较)和精确度(各种方法的r的变异程度s)两个角度进行评价。结果 3种缺失值处理方法的优劣在不同的缺失场景中均有所差异,完全随机缺失(MCAR)和随机缺失(MAR)(1∶2)机制下,当缺失比例小于30%时3种方法的估计值r均在可接受范围(rc±0.5s c);MAR(比例=2∶1)机制任意缺失比例下3种方法的估计值r均在可接受范围内;任意缺失场景下用EM法估计的r的标准误s 最小,且与rc的标准误s c最为接近。结论 在选择缺失值处理方法时,应该考虑数据的缺失比例和缺失机制。  相似文献   

7.
文章首先介绍了医学高等教育教学质量评价中的马尔可夫链模型基本原理,基于医学高等教育的教学过程带有诸多随机因素的特点,运用马尔可夫链建立相应的动态的随机过程模型进行分析和质量评价。通过流行病与卫生统计学学科的教学质量评价的实例检验,证明了将马尔可夫链模型应用到医学高等教育的教学质量评价中的科学性和可行性。最后总结了该方法的优缺点并提出了对其进行改进的思路。  相似文献   

8.
本文简述了贝叶斯定理与马尔可夫过程决策的基本理论,对其数学模型作了简要求证。通过实倒,介绍了上述两类模型在支气管哮喘病诊所开设及在哮喘合并感染病例对抗菌素需求量决策中的方法应用。为使计算简捷,还介绍了马尔可夫分析的计算机程序。经实际决策分析,效果均属满意。  相似文献   

9.
冯妍  冯奇  王以新  邱禹  周雪忠  徐浩 《中国全科医学》2020,23(17):2181-2185
背景 部分可观察马尔科夫决策过程(POMDP)是一种解决序列决策问题的数学算法,在医学领域中常应用于复杂治疗方案的动态优化。其在不稳定型心绞痛(UA)中西医结合临床治疗方案优化中的应用已进行了初步尝试。目的 详细描述POMDP在UA中西医结合临床治疗方案优化过程中的建模方法并对模型的可靠性做出初步验证。方法 收集中国中医科学院西苑医院、中国中医科学院广安门医院、中日友好医院、北京市中医院、通州区中医院、东直门医院、怀柔中医医院、北京大学人民医院2008-2010年2 212例UA患者结构化住院病历111 060条记录。将UA证候要素类型为气虚、血瘀的患者随机分为测试组732例和验证组732例,对测试组患者应用POMDP得出一组最优治疗方案的核心处方,在验证组患者中筛选符合方案的患者(作为优化组),与不符合方案的患者(作为对照组)进行血瘀证积分、远期终点事件(主要终点事件包括心血管死亡、非致命性心肌梗死、血运重建术,次要终点事件包括脑卒中、因急性冠脉综合征再住院、心功能不全、其他血栓并发症)发生情况的比较,验证方案的临床疗效。结果 气虚优化组(n=152)、血瘀优化组(n=127)患者血瘀证积分降分分别为(5.29±2.64)、(4.87±3.04)分,均高于对照组,差异有统计学意义(P<0.05)。气虚优化组、血瘀优化组远期终点事件发生率分别为16.4%(25/152)、12.6%(16/127),与对照组比较,差异无统计学意义(P>0.05)。结论 POMDP可以实现UA中西医结合临床治疗方案的优化,模型经验证较为稳定可靠,可尝试为其他疾病临床方案的制定提供更为细化、深入的优化方案。  相似文献   

10.
谢彦  朱军 《循证医学》2008,8(5):276-278
1文献来源 van Imhoff GW, van der Holt B, MacKenzie MA, et al. Impact of three courses of intensified CHOP prior to high-dose sequential therapy followed by autologous stem-cell transplantation as first-line treatment in poor-risk, aggressive non-Hodgkin's lymphoma: Comparative analysis of dutch-belgian Hemato-Oncology Cooperative Group Studies 27 and 40. [J]. J Clin Oncol, 2005, 23(16):3793-3801.  相似文献   

11.
Objective:To describe the use of the GlideScope in comparison with direct laryngoscopy for elective surgical patients requiring tracheal intubation. Methods:Two hundred patients, ASA Ⅰ - Ⅱ scheduled for elective surgery under general anesthesia requiring orotracheal intubation were selected. Information was collected identifying the patient demographics and airway assessment features (Mallampati oropharyngeal scale, thyromenta distance and mouth opening). In a random crossover design, after induction of anesthesia and neuromuscular block, the laryngoscopes were inserted in turn, and the views of the glottis at laryngoscopy (Cormack and Lehane scores) were compared. The tracchea was intubated using either the standard Macintosh laryngoscope or GlideScope after the second grading at laryngoscopy was done. Complications associated with intubating were recorded. Results: There were 200 patients including 107 males and 93 females, with mean age being 52±13 years, height 164.8±11.3 cm, weight 64.0±11. 5 kg, thyromental distance 6. 9± 1.1 cm, and mouth opening 5.7±0.5 cm. There was a significant association between the preoperative view of the oropharynx (Mallampati score) and the view of the glottis at laryngoscopy for both the direct Macintosh laryngoscope (P〈0. 001) and the GlideScope (P〈0. 001). Among 200 patients, 106 patients had the same C&L grade, 91 of remaining patients showed improvement in the C&L grade (P〈0. 001 ) obtained with GlideScope compared with the direct Macintosh laryngoscope. 3 of remaining patients showed better view of the glottis(C&L grade) with the direct Macintosh laryngoscope (grade 1) than with GlideScope (grade 2). There were no cases of failure to be intubated. There were no cases of dental or mucosal injury in all patients. Conclusion: GlideScope videolaryngoscope yielded comparable or superior laryngeal view compared with Macintosh laryngoscope. The new type of laryngoscope may have potential advantages for managing the d  相似文献   

12.
Hyper-pigmentation is a common, acquired dermatological skin-disorder manifesting and identifiable as irregular brown or greyish-brown facial discolouration, and sometimes referred to as melanosis, melasma or hypermelanosis. Purpose and Objective: To identify the site of melanin deposition in skin-layers regarding facial hyper-pigmentation, based on a histological study of full-thickness skin-facial biopsies in aged Caucasian-cadavers. Hypothesis: Recalcitrant hyper-pigmentation, is chiefly characterised by hyper-melanosis restricted to the dermal-layer of the integument. Method: The histological features of facial hyper-pigmentation and solar-lentigenes were evaluated in a pilot-study of 5-randomly selected Caucasian-cadavers with pigmentation (15 facial biopsies), ranging in age between 75 and 102 years (mean 77-years). Selection-criteria included, both genders, age 〉 75, focal and confluent hyper-pigmented lesions, involving sun-exposed areas of skin (centrifacial, scalp, malar, mandibular and cervical). Study groups included (Grp-1: Control skin-histology in otherwise normal aged, human-cadavers; Grp-2: Histology of pigmented facial skin-lesions in man; Grp-3: Comparative histological skin-controls in non-human primates). No obvious hepatic disease was evident in the cohort studied. Twenty-five histological controls were obtained from non-pigmented areas. Histological evaluation of full-thickness skin-biopsies (including the lesion, edge and peri-]esion skin), was under a Leitz~-light-microscope, and staining included H&E, Masson-trichrome, Masson-fontana, Alcian-blue and Verhoef technology. Histological-scoring used was on histological deposition of melanin in skin-layers: epidermal, dermal, mixed, and indeterminate melanin-deposition (score 1-4). Controls included cadaveric skin-biopsies of human races of colour and non-human primate, Cercopethicus Aethiops (latter is known to have predominantly dermal-melanin deposition). Pigmented and non-pigmented areas were compared in both species. Results: The majority of clinically visible individual and confluent areas of hyper-pigmentation studied were maeroscopically present on the forehead, frontal scalp in hair-receded cadavers, molar and temporal zones. Histologically, documented features of age-related changes without pigment were present in almost all the embalmed cadaver-skins, with a melanin-score of 1. Computer enhanced skin geometry and biometrics confirmed the presence of an aged-skin, pigmentation and features of solar damage. The human embalmed-tissue was well preserved and minimal autolytic changes were present. Special stains of full-thickness biopsies (Masson-Fontana), showed that melanin in the subhuman-primate is lodged in the deep dermis (reticular dermis), within the extra-cellular matrix (ECM) and superficial to the hypodermal adipose-tissue (melanin-score 3). Fifteen pigmented lesions studied in five (5) aged-cadavers (forehead, molar and mandibular areas) all showed predominantly epidermal-deposition of melanin in the basal, suprabasal and stratum corneum with tiny focal areas of dermal melanosis in single-cell macrophages in the papillary-dermis but not reticular-dermis (melanin-score 2). A melanin-deposition localization ratio of epidermis to dermis was approximately 98 to 2% in cadavers with hyper-pigmentation. Conclusion: The skin-strata localization of the melanin with regards hyper-pigmentation of the face and forehead in this aged, human adult Caucasian, cadaveric-study, was predominantly in the epidermis and sparse in the papillary dermis.  相似文献   

13.
目的 探讨Markov模型预测合肥市疟疾发病率的可行性,为全市的疟疾防治工作提供科学依据.方法 应用Excel软件对合肥市1990~ 2010年疟疾发病率建立Markov模型,预测合肥市2011~ 2012年的疟疾发病率.结果 利用建成的Markov模型预测合肥市2011~2012年疟疾发病率均在1/10万~ 3.5/10万之间,而2011年和2012年实际发病率分别为0.13/10万和0/10万,预测结果与实际情况不符.结论 本次模拟的Markov模型不适合预测合肥市疟疾的发病情况.  相似文献   

14.
The aim of this study was to purify and characterize a keratinase produced by a new isolated Bacillus subtilis KD-N2 strain. The keratinase produced by the isolate was purified using ammonium sulphate precipitation, Sephadex G-75 and DEAE (diethylaminoethyl)-Sepharose chromatographic techniques. The purified enzyme was shown to have a molecular mass of 30.5 kDa, as determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) analysis. The optimum pH at 50 ℃ was 8.5 and the optimum temperature at pH 8.5 was 55 ℃. The keratinase was partially inactivated by some metal ions, organic solvents and serine protease inhibitor phenylmethanesulfonyl fluoride (PMSF). Sodium dodecyl sulfate (SDS) and ethylene diamine tetraacetic acid (EDTA) had positive effect on the keratinase activity. Reducing agents including dithiothreitol (DTT), mercaptoethanol, L-cysteine, sodium sulphite, as well as chemicals of SDS, ammonium sulfamate and dimethylsulfoxide (DMSO) stimulated the enzyme activity upon a feather meal substrate. Besides feather keratin, the enzyme is active upon the soluble proteins ovalbumin, bovine serum albumin (BSA), casein and insoluble ones as sheep wool and human hair. Calf hair, silk and collagen could not be hydrolyzed by the keratinase.  相似文献   

15.
Apolipoprotein B (apoB) is the main protein component of very low density lipoprotein (VLDL) and is necessary for the assembly and secretion of these triglyceride (TG)-rich particles. Following release from the liver, VLDL is converted to low density lipoprotein (LDL) in the plasma and increased production of VLDL can therefore play a detrimental role in cardiovascular disease. Increasing evidence has helped to establish VLDL assembly as a target for the treatment of dyslipidemias. Multiple factors are involved in the folding of the apoB protein and the formation of a secretion-competent VLDL particle. Failed VLDL assembly can initiate quality control mechanisms in the hepatocyte that target apoB for degradation. ApoB is a substrate for endoplasmic reticulum associated degradation (ERAD) by the ubiquitin proteasome system and for autophagy. Efficient targeting and disposal of apoB is a regu- lated process that modulates VLDL secretion and partitioning of TG. Emerging evidence suggests that significant overlap exists between these degradative pathways. For example, the insulin-mediated targeting of apoB to autop- hagy and postprandial activation of the unfolded protein response (UPR) may employ the same cellular machinery and regulatory cues. Changes in the quality control mechanisms for apoB impact hepatic physiology and pathology states, including insulin resistance and fatty liver. Insulin signaling, lipid metabolism and the hepatic UPR may impact VLDL production, particularly during the postprandial state. In this review we summarize our current understanding of VLDL assembly, apoB degradation, quality control mechanisms and the role of these processes in liver physiology and in pathologic states.  相似文献   

16.
周杰  杨冬阳 《循证医学》2012,12(2):89-91
3背景 死者捐赠肝脏移植给慢性肝功能衰竭的患者改善了优先患者的肝移植5年生存获益。巴塞罗那临床肝癌(Barcelona clinic liver cancer.BCLC)分期确定为评估肝癌患者预后的标准。  相似文献   

17.
Atrial fibrillation is the most common arrhythmia affecting patients today. Disease prevalence is increasing at an alarming rate worldwide, and is associated with often catastrophic and costly consequences, including heart failure, syncope, dementia, and stroke. Therapies including anticoagulants, anti-arrhythmic medications, devices, and non-pharmacologic procedures in the last 30 years have improved patients" functionality with the disease. Nonetheless, it remains imperative that further research into AF epidemiology, genetics, detection, and treatments continues to push forward rapidly as the worldwide population ages dramatically over the next 20 years.  相似文献   

18.
Abnormal intracellular accumulation or transport of lipids contributes greatly to the pathogenesis of human diseases. In the liver, excess accumulation of triacylglycerol (TG) leads to fatty liver disease encompassing steatosis, steatohepatitis and fibrosis. This places individuals at risk of developing cirrhosis, hepatocellular carcinoma or hepatic decompensation and also contributes to the emergence of insulin resistance and dyslipidemias affecting many other organs. Excessive accumulation of TG in adipose tissue contributes to insulin resistance as well as to the release of cytokines attracting leucocytes leading to a pro-inflammatory state. Pathological accumulation of cholesteryl ester (CE) in macrophages in the arterial wall is the progenitor of atherosclerotic plaques and heart disease. Overconsumption of dietary fat, cholesterol and carbohydrates explains why these diseases are on the increase yet offers few clues for how to prevent or treat individuals. Dietary regimes have proven futile and barfing surgery, no realistic alternatives are at hand as effective drugs are few and not without side effects. Overweight and obesity-related diseases are no longer restricted to the developed world and as such, constitute a global problem. Development of new drugs and treatment strategies are a priority yet requires as a first step, elucidation of the molecular pathophysiology underlying each associated disease state. The lipid droplet (LD), an up to now over- looked intracellular organelle, appears at the heart of each pathophysiology linking key regulatory and metabolic processes as well as constituting the site of storage of both TGs and CEs. As the molecular machinery and mechanisms of LDs of each cell type are being elucidated, regulatory proteins used to control various cellular processes are emerging. Of these and the subject of this review, small GTPases belonging to the Rab protein family appear as important molecular switches used in the regulation of the intracellular trafficking and storage of lipids.  相似文献   

19.
Background IIIb-T4 non-small cell lung cancer (NSCLC) is commonly considered a contraindication to surgery, although chemo-radiotherapy also achieves a poor survival rate. We reviewed our experience with T4 NSCLC patients who underwent surgery to explore the indications and prognostic factors of surgical treatment of lung cancer invading the left atrium and great vessels. Methods We investigated a cohort of 105 patients, 79 men and 26 women, who underwent surgery from May 1996 to July 2008. Their pathological staging was T4No-2M0. The median age was 59 years, ranging from 36 to 75 years. Patients were grouped based on invading sites: tumors invading the left atrium (LA group), tumors invading the superior vena cava (SVC group), and tumors invading the intrapericardial pulmonary artery (PA group). Patients were further characterized based upon the type of operation, complete resection and incomplete resection groups, and on the lymph node pathological status, No, N1 and N2 groups. We calculated the overall five-year survival rate. Results All patients received resection of primary lesions, with partial resection of the left atrium in the LA group (n=-25), angioplasty of superior vena cava in the SVC group (n=-23) and intrapericardial ligation of the pulmonary artery in the PA group (n=57). Complete resection was possible in 77 patients (73.3%). The overall survival rate of the 105 patients was 41.0% at 5 years; 36.0% for the LA group, 34.8% for the SVC group and 45.6% for the PA group. Pathological N status significantly influenced the overall 5-year survival rate; 61.5% for No, 51.1% for the N1 and 11.8% for the N2 groups (N2 group versus No group, P 〈0.0001, N2 versus N1 group, P〈0.0001). Surgical resection also influenced survival; 49.4% for the complete resection group and 17.9% for the incomplete resection group (P 〈0.0001). Cox regression analysis demonstrated that pathological N status was a significant independent predictor of prognosis. Conclusions Pathological N status is a significant independent predictor for survival of patients with IIIb-T4 lung cancer invading the left atrium and great vessels. The completeness of resection has a significant influence on the overall 5-year survival rate. Surgery for T4 lung cancer may be effective in patients without mediastinal lymph node involvement.  相似文献   

20.
Lipids are important constituents of the neuronal membrane. Also, kinds of fatty acids were supplied in the diet can affect the brain growth and the onset of myelinogenesis. So, in this study, the effect of oleic acid and palmitic acid on sensorimotor coordination and cerebellum histological changes was investigated. In present study, 9 groups (10 rats in each group) of Wistar immature rats were used. One group kept as control with similar environmental conditions to other groups. Four groups of rats were fed with diet containing 10% palmitic acid for 1 to 4 weeks respectively. Four groups of rats were fed with diet containing 10% oleic acid for 1 to 4 weeks respectively. After maturation (age at 90 weeks), the rats were tested for motor activity task by using Rota rod based on standard method and then the whole cerebellum were removed and samples were fixed in bouin for routine paraffin embedding method. The results showed that sensorimotor coordination was significantly (p 〈 0.01) increased in rats fed with oleic acid for 4 weeks. The sensorimotor coordination was significantly (p 〈 0.01, p 〈 0.5) increased in groups received palmitic acid for 1 and 2 weeks. Also, diameter of cerebellum was significantly (p 〈 0.001, p 〈 0.5) changed with oleic acid for 4 weeks and palmitic acid for 2 weeks. The diameter of molecular layer of cerebellum was significantly (p 〈 0.001, p 〈 0.5) changed with oleic acid for 2 and 4 weeks. Thus, palmitic and oleic acid can improve function of tissue of cerebellum in rat.  相似文献   

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